Emergency Medicine: Heart Attack and CPR
A blood clot is the most common cause of a blocked coronary artery. Usually, the
artery is already partially narrowed by atheromas. An atheroma may rupture or
tear, narrowing the artery further and making blockage by a clot more likely.
The ruptured atheroma not only reduces the flow of blood through an artery but
also releases substances that make platelets stickier, further encouraging clots
Uncommonly, a heart attack results when a clot forms in the heart itself, breaks
away, and lodges in a coronary artery. Another uncommon cause is a spasm of a
coronary artery that stops blood flow. Spasms may be caused by drugs. Sometimes
the cause is unknown.
Heart Attack: Myocardial Infarction (MI)
Signs and Symptoms present as pain that is crushing, tightness, squeezing,
band-like, radiating, cyanosis, sweating, cold, "clenching fist over heart",
pain in the ear, umbilicus, jaw, teeth, back, arm, hand pain (often on the ulnar
side), autonomic response of vomiting, nausea or a feeling of impending doom.
About one third of people who have a heart attack do not have chest pain. Such
people are more likely to be women, people who are not white, those who are
older than 75, those who have heart failure or diabetes, or those who have had a
Heart attack symptoms for women can be slightly different and present with a feeling of faintness, sudden heavy sweating, nausea, shortness of breath and a heavy pounding of the heart.
Abnormal heart rhythms (arrhythmias) occur in more than 90% of people who have
had a heart attack. Immediately and up to a few days after a heart attack,
abnormal heart rhythms are a common reason that the heart cannot pump
adequately. Abnormal heart rhythms originating in the ventricles (ventricular
arrhythmias) may greatly interfere with the heart's pumping ability or may cause
the heart to stop pumping effectively (cardiac arrest). A loss of consciousness
or death can result. Sometimes loss of consciousness is the first symptom of a
If you suspect a heart attack, seek emergency medical treatment immediately.
Should a heart attack occur, you should go to the emergency room and seek help
immediately. Time is of essence. Only examination by a doctor, who will
administer an electrocardiogram (EKG) and/or a blood test, can confirm if you
are having a heart attack.
The most important thing to do if you think you are having heart attack
Dial 911 to call an ambulance or get to a hospital emergency room as quickly as
possible so the doctor can examine and treat you.
Crush or chew a full-strength aspirin (swallow with a glass of water) to prevent
further blood clotting.
Cardiopulmonary Resuscitation (CPR)
Cardiopulmonary Resuscitation (CPR) is a combination of rescue breathing and
chest compressions delivered to victims thought to be in cardiac arrest. When
cardiac arrest occurs, the heart stops pumping blood. CPR can support a small
amount of blood flow to the heart and brain to "buy time" until normal heart
function is restored.
To learn CPR properly, take an accredited first-aid training course, including
CPR and how to use an automatic external defibrillator (AED).
Before you begin, assess the situation before starting CPR:
Is the person conscious or unconscious?
If the person appears unconscious, tap or shake his or her shoulder and ask
loudly, "Are you OK?"
If the person doesn't respond and two people are available, one should call 911
or the local emergency number and one should begin CPR.
If you are alone and have immediate access to a telephone, call 911 before
beginning CPR unless you think the person has become unresponsive because of
suffocation (such as from drowning). In this special case, begin CPR for one
minute and then call 911.
If an AED is immediately available, deliver one shock if advised by the device,
then begin CPR.
Remember the ABCs
Think ABC - Airway, Breathing and Circulation - to remember the steps explained
below. Move quickly through Airway and Breathing to begin chest compressions.
AIRWAY: Clear the airway
Put the person on his or her back on a firm surface. Kneel next to the person's
neck and shoulders. Open the person's airway using the head-tilt, chin-lift
maneuver. Put your palm on the person's forehead and gently tilt the head back.
Then with the other hand, gently lift the chin forward to open the airway.
Check for normal breathing, taking no more than five or 10 seconds: Look for
chest motion, listen for breath sounds, and feel for the person's breath on your
cheek and ear. Gasping is not considered to be normal breathing.
If the person isn't breathing normally and you are trained in CPR, begin
mouth-to-mouth breathing. If you believe the person is unconscious from a heart
attack and you haven't been trained in emergency procedures, skip mouth-to-mouth
rescue breathing and proceed directly to chest compression.
BREATHING: Breathe for the person
Rescue breathing can be mouth-to-mouth breathing or mouth-to-nose breathing if
the mouth is seriously injured or can't be opened.
With the airway open (using the head-tilt, chin-lift maneuver) pinch the
nostrils shut for mouth-to-mouth breathing and cover the person's mouth with
yours, making a seal.
Prepare to give two rescue breaths. Give the first rescue breath lasting one
second and watch to see if the chest rises. If it does rise, give the second
breath. If the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and
then give the second breath. Begin chest compressions to restore circulation.
CIRCULATION: Restore blood circulation with chest compressions
Place the heel of one hand over the center of the person's chest, between the
nipples. Place your other hand on top of the first hand. Keep your elbows
straight and position your shoulders directly above your hands.
Use your upper body weight (not just your arms) as you push straight down on
(compress) the chest 2 inches (approximately 5 centimeters). Push hard and push
fast give two compressions per second, or about 120 compressions per minute.
(NEW GUIDELINES - as of 1/2/2011 - an easy way to remember the compression
rhythm is to the song Staying Alive from the motion picture,Saturday Night
After 30 compressions, tilt the head back and lift the chin up to open the
airway. Prepare to give two rescue breaths. Pinch the nose shut and breathe into
the mouth for one second. If the chest rises, give a second rescue breath. If
the chest doesn't rise, repeat the head-tilt, chin-lift maneuver and then give
the second rescue breath. That's one cycle. If someone else is available, ask
that person to give two breaths after you do 30 compressions.
If the person has not begun moving after five cycles (about two minutes) and an
automatic external defibrillator (AED) is available, apply it and follow the
The American Heart Association recommends administering one shock, then resuming
CPR - starting with chest compressions - for two more minutes before
administering a second shock.
If you're not trained to use an AED, a 911 operator may be able to guide you in
its use. Trained staff at many public places are also able to provide and use an
Continue CPR until there are signs of movement or until emergency medical
personnel take over.
Andrew Pacholyk, MS. L.Ac
Therapies for healing
mind, body, spirit
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